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Opioid Prescribing Habits of ED Physicians Can Affect Patient Usage Long Term

February 28th, 2017

BOSTON – Emergency physician prescribing practices can be a factor in whether patients receiving opioids end up using them long term.

That’s according to a study published recently in the New England Journal of Medicine. In fact, researchers from Harvard Medical School and T.H. Chan School of Public Health found that patients being treated by ED physicians who prescribe opioids more often are at greater risk for long-term opioid use even after a single prescription than those who see less-frequent prescribers.

Pointing out that long-term opioid use increases the danger of misuse, addiction, and overdose, study authors emphasize the importance of educating physicians on better narcotic prescribing and reducing wide variation in prescribing patterns.

“These are sobering results,” emphasized lead author Michael Barnett, MD, MS, assistant professor of health policy and management at the Harvard Chan School and an HMS instructor of medicine at Brigham and Women’s Hospital. “Our analysis suggests that one out of every 48 people newly prescribed an opioid will become a long-term user. That’s a big risk for such a common therapy.”

The study compared opioid use during 12 months following an initial ED encounter among more than 375,000 Medicare beneficiaries treated by more than 14,000 physicians between 2008 and 2011.

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With a sample of 215,678 patients who received treatment from low-intensity prescribers and 161,951 patients who received treatment from high-intensity prescribers, the study found that rates of opioid prescribing in hospitals varied significantly between low-intensity and high-intensity prescribers – 7.3% vs. 24.1%.

In addition, results indicate that long-term opioid use was significantly higher among patients treated by high-intensity prescribers than among patients treated by low-intensity prescribers, for an adjusted odds ratio of 1.30.

In effect, patients treated by the most frequent prescribers were 30% more likely to become long-term opioid users – defined as receiving six months of pills in the 12 months following the initial encounter. They also were more likely to have an adverse outcome related to the drugs, such as a fall, a fracture, respiratory failure, or constipation, study authors note.

“Who treats you matters. Our findings lend support to the narrative that we often hear – a patient happened to be prescribed an opioid by a dentist or in the emergency room and unwittingly became a long-term user,” added co-author Anupam Jena, MD, PhD. “A physician who prescribes an opioid needs to be conscious that there is a significant risk that the patient could continue to be on an opioid for the long term, even from a single, short, initial prescription.”

Interestingly, the study found that patients treated by low-frequency prescribers were no more likely to return to the hospital overall or with the same complaints — which the researchers interpret as evidence that they were not undertreated for their symptoms.

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